Book reviews

Why We Feel That Way. By A~SGUSTI~S W. TRETTIEN, Ph. D. The Stratford Company, Boston, 1935. 441 pages, bibliography, glossary and index. Price $3.00. Before reading far into this book, one is convinced that it has been addressed to the lay reader. To say that the market is flooded with literature (save the mark !) that strives to interpret scientific knowledge for the uninitiated, is not to east a slur upon honest efforts to enlighten the public. This author has faced a difficult task and has come away" with a more satisfactory product than is usually the ease; at any rate, he has avoided the sensationalism to which many others have resorted. Beginning students in psychology, however, are likely to take Dr. Trettien's book in hand with the feeling that they have something quite reliable, in which case they should be disillusioned. It is regrettable that in the glossary one finds inaccuracies that foree ls to warn the unwary. Faulty impressions will be gleaned from the definitions that may hamper the student in his progress. To quote an example: TRAUMA--Pertaining to pain. There are several others. In the face of such vocabulary weakness, how much better it would have been to omit the glossary altogether and to refer the reader to some authoritative reference work. Informed readers will be puzzled and neophytes grievously misled by the title for Chapter XVII: "Crime and Its Emotional Psychosis." It is clear that the author bandies his terms about with little regard for their true connotations. Reference is made to some commendable authorities, as well as to some who bear little weight. In general, the early student of psychology will welcome the simplification of phrasing; the exposition of the theories of emotions in the 11 pages of Chapter I I I shows an economy of expression that is essential to orientation. The book will not be of interest to the psychiatrist; the lay reader should add pinches of salt throughout the reading.

In the Preface to this Work we meet with the following ftatement of the views with which it was compofed.
(t The writer of the enfuing pages has laboured to render the difquifitions that they contain, at the fame time open to general obfervation, and interesting to the profeflional fludent. He has attempted to delineate a portrait, the prominent character of which fhall be univerfally under-Ilood, while the more minute lines and fhades of expreffion lhall remain for detection by the {kill of the artift." In purfuance of this plan, our author introduces his fubjeft with a flight Iketch of thofe different hypothefes which have, at various periods, been conftru&ed in order to explain the nature and origin of what he conceives neceffary to the aftual exiftence of genuine phthifis, ulcer ia the lungs, and hedic fever. The principal errors of fuch hypothefes are attributed, by Dr. Reid, to a negledt on the part of their founders, of regarding life as an effett, produced and fupported by influences totally diftindt in their nature from thofe which regulate the economy of the inanimate creation.
Theories of difeafe were deduced from the principles of loofe analogical analogicalreafoning ; unprofitable difquifitions into the caufe, for along period, fupplied the place of an attentive inquiry into the laws and charadteriltic qualities of vitality, and the fcience of life remained to be difclofed." That reformation, fo long defired in the conduct of medical refearches, has at length been eftedted, according to the opinion of our author,^ by the enunciation and application of what is generally denominated the Brunonian theory, the outlines of which are defcribed by the following words: " Every change which is effected on the folids or fluids of the living fyftem, is fubordinate to, and consequent upon, a certain degree of aftion in the animate fibre. This adtion is produced upon principles entirely different from the impulfe of mechanism, or the attradlions of inanimate matter.
It is governed by peculiar and exclufive laws. The pow-ers by which it is generated are the powers by which life is fuftained. Health confifts in its regular maintenance. The various modifications of difeafe are in their origin entirely attributable to its derangement, and death is the inevitable and immediate conference of the lofs of fufceptibility to its adtion." The four Succeeding chapters are devoted to a delineation of the ftrudture of the refpiratory organs, an account of the chemical ingredients of atmofpheric air, and a general inquiry into the functions of the lungs and {kin, as far as they are connedted with the propagation and prefervation of animal heat. Our limits will not permit us to fcrutinize the reafonings of Dr. Reid, from which the following inference is deduced, that chemical agency has been too precipitately made to apply to the fundtions both of the lungs and external furface of the body ; and that the generation and dueadjuftmerit of animal temperature, are, like all other phenomena of the living frame, influenced by the peculiar laws of fibrous excitation.
Thofe affedtions are next made to pafs under review, which are frequently precurfors of ulcer in the lungs; thefe are treated of in the following order, Hcemoptyfis, Catarrh, Pneumonia, and Tubercles.
In the chapter on Haemoptyfis, Dr. R. takes ocafion to objedt to thofe accounts of its origin, which he conceives to be relicks of the mechanical and humoral doftrines in pathology. Difcharges of blood from the lungs, our author maintains, in 110 inftance originate according to the opinion of Dr. Cullen and other writers, from a fudden diminution of weight in the atmofphere, adting either upon the principles of mechanifm, or by occafioning the circulating fluids to rarify and expand; an effedt which he contends is altogether inconfiftent with the eltabliflied laws of vital caufation. While confidering the treatment of hemorrhage from the lungs, as likewife the produdlion and treatment ot catarrh and pneumonia, the writer's principles are maintained with much ingenuity of argument, and confiderable force of expreflion.
We were much gratified with obferving, that in his remarks on pneumonia, our author adverts, in an efpecial manner, to the tendency of eruptive diforders in early life> more especially-the inea-H h 3 Aw its caufe.
We are, moreover, difpofed to think that Dr. R. has evinced too great a partiality for fyftem and generalization, in his endeavours to prove that fufceptibility to catarrhal irritation of the mucous membrane, and that the generation of tubercle, exift in the fame ratio.
Violent and reiterated inflammation, we are perfuaded, frequently affett the mucous membrane without being followed by tubercle. .
In the next divifion of his work, Dr. R. confiders the predifpofing and exciting caufe of confumption; and the characters of the phthifical temperament are here pointed out with fo much perfpicuity and accuracy, that we regret our limits do not admit of their detail.
On the means of obviating the confumptive tendency, we find a confiderable coincidence of opinion with another modern author of deferved reputation; a coincidence which will in no meafure detract from the value of thofe precepts which are contained in this important divifion of Dr. R's work.
The progreflive fymptoms of phthifis pulmonalis are traced with fidelity in the enfuing chapter, and the pradical rules, with regard to the treatment of the complaint, difplay much nicety of difcrimination, and correCtnefs of judgment. We conceive, however, that the author would have rendered his treatife more acceptable to the majority of readers, by a more ample detail of both the dietetic and medicinal management of the confumptive invalid. In the earlier ftages of this complaint, Dr. R. fpeaks with much confidence of the powers of Digitalis, the modus operandi of which he endeavours to reconcile with Brunonian principles.
The work now under confideration concludes with additional obfervations on the mode of discriminating between genuine and fpurious phthifis, with an account of the different fpecies and caufes of general decline, and pulmonary confumption ; and with further remarks on the remedies required in confumptive afteCtions, whether independent of, or connected with, an aSual diforder of the lungs.
We fhall finifh our Analyfis by extracting the following para-graphs, which terminate the work, and which we think afford a favourable fpecimenof the general ityle in which it is written. " Coughs are by no means abfolute indications of catarrhal affection. The idea of ? fpecific remedies for coughs and colds,' is founded upon a total ignorance of the laws and functions of the animal economy. It is equally inconfiftent with, and contrary to, both philosophical principles and aftual experience, as the vulgar and empirical notion of correcting impurities in the blood. " Urgent pain is often unaccompanied by inflammation or increafe of local excitement. It is in many inftances confequent upon the difficulty and labour with which an enfeebled organ performs its accultomed and falutary aftion. An important demand for invigorating refources is too commonly fupplied by enervating powers.
The fiuffied cheek and emaciated countenance, are the moll faithful attendants upon genuine phthifis. Even thefe, however, are not abfolute indications either of the prefence or abfence of pulmonary confumption. " A familiarity with the phyfiognomy of this difeafe can only be acquired by an affiduous attention to its ever varying (hades, and by carefully marking its multifarious expreflions. In proportion, however, to the difficulty of the tafk is the neceffity of its accomplifnment. Delays and errors are here efpecially to be dreaded. Decilion comes too late, when not merely the nature of the diforder, but likewife its fatal termination, almoft ceafes to be a fubjeft of doubt or enquiry. To know the rocks on which his veffel has foundered, affords but ("mall  We know not whether most to admire the benevolent intentions of this author, his persevering industry, or the accuracy and minuteness of his observation under so long a series of experiments.
If ever there was a subject which authorized experiments on brute animals more than another, it is the one before us. It was not with a view of establishing some uncertain theory, some unimportant doctrine, the favourite invention of his brain, but from the sole motive of relieving his fellow creatures under circumstances which admit of no delay, that these enquiries and communications have been made.
That our readers may be enabled to follow us through the rest ot the work, we shall transcribe the first chapter, entitled, preparatory considerations. " 1 ho changes produced on arteries by accidents, and the sur-II h 4 gical gical operations to which they are subjected, have a certain relation to their structure. The subjects, therefore, of this Treatise naturally suggest a few preliminary observations on the structure of arteries; but only such a description will be given, as may suffice for the explanation of the phenomena which they exhibit,'* when influenced by accident or art. " The substance of which arteries are composed is divisible into, distinct parts, which have been called tunics or coats. Three coats, which have received various names, can be readily demonstrated, and may be simply and clearly distinguished hy the terms ?Internal, Middle, and External.
" The-internal coat, although extremely thin, is very close in its texture, and gives to an artery a smooth and polished lining; it is elastic, and firm, considering its delicate structure, in the longigitudinal direction, but so iceak in the circular as to be very easily torn by the slightest force applied in that direction. The morbid changes, which have been observed in it, prove that this coat is vascular ; and some experiments have been related to show the probability of its being sensible. <? The middle coat, which is the thickest, is formed by numerous layers of firm, compact, fleshy fibres of a pale red colour, passing in a circular direction, but appearing rather obliquely connected and interlaced with each other, than forming complete circles. These fibres are of a peculiar nature, are well supplied with nerves, and resemble in form and disposition, muscular fibres, but differ from them in possessing a remarkable degree of elasticity. Then* elasticity keeps an empty and dead artery open and circular; for this coat, when detached from the internal and external coats, still preserves a cylindrical form, whilst the)'', on the contrary, in a state of separation, become flaccid and collapse. As this coat has no longitudinal fibres, the circular fibres arc held together by a slender connection, which yields readily to any force applied in the circumference of the artery. The middle coat is intimately connected with the internal and external by very short and fine cellular membrane. " The external coat, anatomically considered, is so simple,, that many authors have thought it sufficient to say, that it is formed of condensed cellular membrane, which becoming gradually of a looser texture, connects the artery with the surrounding paj'ts ; but the importance which is attached* in a surgical view, to this coat, renders a more particular account of it highly necessaiy and interesting. Although ultimately resolvable into cellular m< mbrane, yet it derives from the particular arrangement of its cen ponent fibres a characteristic appearance, which distinguishes it t-iom cellular membrane, and.entitles it to be ranked as a proper cui'j of an artery. Internally, or next to the middle coat, its texr ture is close and smooth, externally more open and rough, in consequence of the cellular membrane by which.it is connected with an additional covering. The whole is remarkable for its whiter Hess* Dr. Jones's Treatise on Hemorrhage-46$ density, and great elasticity. If an artery be surrounded by a tight ligature, its middle and internal coats will be as completely divided by it as they can be by a knife, whilst the external coat remains entire; a fact, which will be commented upon in another part of this treatise, and shewn to be connected with important circumstances.
The strength therefore of an artery depends chiefly on it s external coat, which answers, in some respects, the purpose of a strong fascia, " 1 he three coats which I have just described are the only proper coats of an artery; but the different arteries, while in their natural situation, are surrounded with fine cellular membrane that connects them with additional coverings, called sheaths, which are formed within the cavities of the body by the investing membrane peculiar to each, and in other parts by facia, or cellular membrane. The fine cellular membrane, the bond of connection between arteries and their sheaths, varies in length in different parts, and gives an artery a flocculont appearance. If an artery be divided, the divided parts, owing to their elasticity, recede from each other, and the length of the cellular fibres connecting the artery with the sheath, admits of its retracting a certain way within the sheath ; an important fact, the application of which will be made in a future part of this Treatise, that describes the natural process by which hemorrhage is stopped. inflame when injured, and to pour out coagulating lymph, hy which the injury is repaired, or the tube is permanently closed." This account,, when we consider that the whole of the future experiments arc on arteries, is much too short. We admit the caution of our author in not asserting more than he could prove. He observes, with much propriety, that the elasticity of these fibres, which run in a somewhat circular direction, is the means of preserving the cavity of a dead artery: but as he found that the artery had a considerable degree of elasticity, in its longitudinal direction,'so as to shorten itself when cut, it became him to define the degree and nature of these elastic powers. By determining how much power remained in a dead artery, and comparing it with the living artery, he might ascertain this as far as the subject would admit; the power lost after death being subtracted from what remained, would show the degree of muscular power, which could only exist with life. What remained must be considered as elastic. It was not necessary, however, to pursue this subject experimentally to any extent. Mr. Hunter's experiments are so numerous, and his accuracy so well known, that a few, to strengthen or confute them, would have been sufficient. The only objection we have to the paisage above quoted is, that the author assumes these muscular and elastic powers of arteries, without offering any proofs either from himself, or any other writer. In all other rei spects, this chapter is highly important, and must be constantly kept in view by the reader, particularly the description of the ? cellular sheath, and the manner in which a divided artery contracts within it.
The first section is on the proccss employed by Nature, for suppressing hemorrhage from divided arteries, or, as we should prefer expressing it, on the sources of the constitution, or animai ? economy, for suppressing, &c.
In the first chapter the author gives a very candid and accurate review of the Theories offered by Petit, Morand, Sharp, Porteau, Gooch, Kirkland, White, and J. Bell. In this we were much pleased to observe the just respect shown to those old French writers, to whom we owe so much ; but our obligations to whom arc so seldom acknowledged. Mr. Petit, it is observed, perceiving a coagulum lodged at the inside of the extremity of a divided artery, and also that the external part was immersed in a similar ? substance, concluded that the plug within, and the support without, were the causes of suppressed hemorrhage. M. Morand added to the above causes, the contraction and retraction of divided arteries. The opinions of both these gentlemen, our author, . with a becoming candour, shows, were founded on fact, though as he adds, their opportunities did not allow them to pursue their enquiries far enough. Mr. Sharpe's opinion, as expressed in the, Edition of 1783, is nearly similar to the above. Dr. Jones begins his remarks on M. Porteau's. account, by reffretting how much the value of it is lessened by the severity with \vliich his predecessors are treated. 3\I. Portcau, by making similar experiments to those of Petit, found similar results; but ill stumps which he had an opportunity of examining at different distances of time, after amputation, lie perceived that in some, no coagulum was discoverable within the cavity of the artery, and in others, where coagula appeared, neither its firmness nor adhesion to the vessel, were sufficient to prevent hemorrhage. This induced him to impute the whole to the contraction of the. length and corrugation or constriction of the diameter of the artery.
Mr. Gooch's readiness at adopting Porteau's error, as his own discovery, is next delicately touched upon, and also Mr. Kirkland's opinion, that the suppression of hemorrhage was caused solely by the contraction of the arterial diameter ; in which he was implicitly followed by Mr. White and Mr. Aikin. Rut though Mr. White's principal, if not his only concern, should have been with the unassisted powers of the economy, his conclusions are drawn from the condition of a tied artery. Mr. J. Bell's Theory, being the last that has been offered, and the most likely to interest the rising generation ; we shall offer our author's remarks upon it, in his own words. " The last theory which I have to notice, is that lately published by Mr. J. Bell, who, after freely criticising those which I have already mentioned, confidently asserts, that, " when lic-(t morrhage stops of its own accord, it is neither from the re-" Supposing the artery still larger and more powerful, and " that it drives its blood very furiously among the cellular subu stance, it is not this slight injection of the cellular substance " that will restrain the bleeding. Whenever the finger is re-" moved the blood bursts through this slight impediment. The " injected cellular substance will not support the artery, unless " the cellular substance itself be also supported. ..." " " Retraction of the artery has no effect in " suppressing hemorrhagy, but as it fills the cellular substance; and this injection of the cellular substance is but a slight obstacle, " fit to support only the very smallest arteries. The natural *' powers which restrain hemorrhagy, do but suppress it for a " time, and expose the patient to secondary hemorrhage." " According to Mr. Bell's first position it appears, that the injection of blood into the cellular membrane which surrounds the artery, is the only natural cause, by which hemorrhage is stopped ; but as he has just before said that it is not stopped by the formation of clots, we are at a loss to know how this injection of the cellular membrane effects the suppression of hemorrhage. If we have recourse to his explanation, our curiosity is not gratified, and our embarrassment certainly not diminished, for we there find that the cellular membrane is only " slightly injected with " blood," so that we are not at liberty to infer that it is so completely injected as to compress the artery, and in that way stop the flow of blood. Indeed, however plausible such an assertion might have made the doctrine, it would not have been valid!:i but, continues the author, " that blood coagulates, and *' that slight barrier is sufficient to restrain the bleeding of a small " artery, &e." But what is the nature of this barrier ? and in what manner does it stop the hemorrhage ? for it is to be remembered that we are previously informed, in positive terms, that it is not stopped by the formation of clots ; and although, in conformity with this, it is not said that the blood is effused into the cellular membrane, at the mouth of the artery, but round it, yet from what has been said above, it must, I think, be pretty evident that an effectual compression of the artery is not implied. " Left then, as we have been by the author, to make the best we can of the theory and explanation, the only conclusion at which we can arrive without assistance from him, is, that hemorrhage is not stopped "by the formation of clots, but by the cellular substance, which surrounds the artery, being injected with blood, which,, according to the illustration, coagulates but as the artery is every wheresurrounded: with cellular substance, the coagulated blood, which stops the hemorrhage, must necessarily be;in the cellular substance; we have, therefore, only to discuss the difference between a clot of blood and coagulated blood, to discover the principal difference between this offspring of Mr. Bell, atnd what ho has been pleased to-call. Petit's " sickly child." " Retraction of tlitf artery," says Mr. Bell, " has-no effect* in suppressing ?suppressing hemorrhagy, but as it fills the cellular substance." But let il be observed, that besides filling the cellular substance round the artery, it also fills the cellular "substance at the mouth ?of the artery in a particular mariner; for the divided artery, by its retraction within its cellular sheath, leaves a space of a determinate form, which, all the circumstances necessary for the suppression of hemorrhage operating, is gradually filled up by a distinct clot. If Mr. Bell really means to confine his doctrine of the natural means of suppressing hemorrhage to the injection of the cellular membrane round the artery with blood ; he dwells improperly on one of the attendant1 circumstances to the exclusion ot the retraction and contraction of an artery, and the formation of a distinct clot ? all of them primary means in the natural suppression of hemorrhage, of which abundant proofs will be given in the proper place. " I have chosen to set Mr. Bell's theory in its strongest and best point of view, by confining it to the injection of the cellular membrane with blood; for, in justice to his physiological knowledge, I think it unnecessary to examine the accuracy of the reasoning, by which he would shew, that the blood forsakes the vpen artery ; rather supposing, that, on this occasion, he has hastily adopted the account given by the Editor of the Memoires de l'Academie Royale des Sciences for the year 1735; who, in giving an abstract of Petit's paper, for the year 1731, says, " Dans le cas d'un tronc d'artere coupe, le sang qui continue de s'y rcndrct ne doit plus y couler que jusqu'a I'endroit, ou il rencontrera une branche collateral entiere dont il enjilera la route, au moyen de quoi la circulation s'achevera," And I am still less disposed to dwell on the inconsistency of introducing the surgeon's finger as an auxiliary to the natural means by which hemorrhage is stopped." . After this account of the labours of his predecessors, our author begins the history of his " experiments on the arteries of dogs and horses, to ascertain the process, and the order of the ?events which constitute it." We shall not enter into a detail of these at present, reserving our remarks on some particular passages to the conclusion drawn from the experiments. Suffice it to say, that equal industry and judgment are shown in every part; that the result is perfectly satisfactory ; that if there is any thing to which we object, it is, adopting Dr. Jones's own expression, " to the manner of accounting for the appearances which lie observed." However, as we cannot add, that " his doctrine could only have been deduced from the irregular and partial observations which he was enabled to make," we would not wish that our objections should be considered in any other light than as opinions, which the reader will receive or reject as he pleases. " The results (says our author) of the experiments related in the last section will not allow us to give so conscise and simple an account of the process, as has hitherto been done ; but they afford US us one more satisfactory, becaue it accords better with'the operations of the animal ceconomy, in which we arc accustomed to observe the most important changes gradually produced by the co-operation of several means, rather than by the sole influence of any one in particular. " They accordingly shew, that the blood, the action and even the structure ot arteries, their sheath, and the cellular substance connecting them with it ; in short, that all the parts concerned in or affected by hemorrhage, contribute to arrest its fatal progress, by operating, in the case of a divided artery of moderate size, in the following manner. " An impetuous flow of blood, a sudden and forcible retraction of the artery within its sheath, and a slight contraction of its extremity, are the immediate and almost simultaneous effects of its division. The natural impulse, however, with which the blood is driven on, in some measure counteracts the retraction, and resists the contraction of the arteryr The blood is effused into the cellular substance between the artery and its sheath, and passing through that canal of the sheath which had heen formed by the retraction of the artery, flows freely externally, or is extravasated into the surrounding cellular membrane, in proportion to the open or confined state of the external wound. The retracting artery leaves the internal surface of the sheath uneven by laceiating or stretching the cellular fibres that connected them. These fibres entangle the blood as it flows, and thus the foundation is laid for the formation of a coagulum at the mouth of the artery, and which appears to be completed by the blood, as it passes'through this canal of the sheath, gradually adhering and coagulating around its internal surface, till it completely fills it tip from the circumference to the centre. " A certain degree of obstruction to the hemorrhage, which results from the effusion of blood into the surrounding cellular membrane, and between the artery and its sheath, but particularly the diminished force and velocity of the circulation, occasioned by the hemorrhage, and the speedy coagulation of the blood, which is a well known consequence of such diminished action of the vascular system, most essentially contribute to the accomplishment of this important and desirable effect. " A coagulum then, formed at the mouth of the artery, and within its sheath, and which I have distinguished in the experiments by the name of 'the external coagulum, presents the first complete barrier to the effusion of blood. This coagulum, viewed externally, appears like a continuation of the artery, but on cutting open the artery, its termination can be distinctly seen with the coagulum completely shutting up its mouth, and inclosed in its sheath.

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The mouth of the artery being no longer pervious, nor a collateral branch very near it, the blood just within it is at rest, coagulates, and forms, in general, a slender conical coagulum, which, which neither fills up the canal of the artery, nor adheres to its sides, except by a small portion of the circumference ot its base, which lies near the extremity of the vessel. This coagulum is distinct from the former, and I have called it the internal coagulum. " In the mean time the cut extremity of the artery inflames, and the vasa vasorvm pours out lymph, which is prevented from, escaping by the external coagulum. This lymph Jills vp the extremity of the artery, is situated between the internal and external coagula of blood, is somewhat intermingled with them, or adheres to them, and is firmly united, all round to the internal coat of the arteri/., " The permanent suppression of the hemorrhage chiefly depends 011 this coagulum of lymph ; but while it is forming within, the extremity of the artery is farther secured by a gradual contraction which it undergoes, and by an effusion of lymph between its tunics, and into the cellular membrane surrounding it; in consequence of which these parts become thickened, and so completely incorporated with each other, that it is impossible to distinguish one from the other: thus, not only is the canal of the artery obliterated, but its extremity also is completely effaced, and blended with the surrounding parts. " "When the wound in the integuments is not healed by the first intention, coagulating lymph, which is soon effused, not only attaches the artery firmly to the subjacent and lateral parts, but also gives it a new covering, and completely excludes it from the external wound, which then goes on to fill up and heal in the usual manner. " The circumstances now described are observed also in the inferior portion of the artery, or that which is supplied with blood by anastomosis; with this difference only, that its orifice is generally more contracted, and the external coagulum is much, smaller than the one which adheres to the mouth of the superior portion of the artery, or that from which the blood flows in its direct course from the heart. " From this view of the subject we can no longer consider the suppression of hemorrhage as a simple or mere mechanical effect, but as a process performed by the concurrent and sucessive operations of many causes : these may briefly be stated to consist in the retraction and contraction of the artery ; the formation of a coagulum at its mouth ; the inflammation and consolidation of it* extremity by an effusion of coagulating lymph within its canal, between its tunics and in the ccllular substance surrounding it. " And we may conclude that, except in some rare instances, in which the strong retraction and contraction of a divided or lacerated artery prevents hemorrhage altogether, a languid state of the circulation is necessary for the accomplishment of the natural means by which the hemorrhage is stopped. These means may be divided into the temporary and permanent: under the fornjer head .we may include the three first of the above-mentioned causes; causes ; whilst the eft'usion of lymph constitutes tlie permanent: yet even these can be distinctly traced only for a certain time, in consequence of other changes which the artery gradually undergoes.
Its obliterated extremity no longer allowing the blood to circulate through it, the portion which lies between it and (he first lateral branch is no more distended and excited to action as formerly; but gradually contracts, till at length its cavity is completely obliterated, and its condensed tunics assume a ligamentous appearance. At the same time, the remarkable appearances at the extremity of the artery are undergoing a considerable change ; the external coagulum of blood, which in the first instance had stopped the hemorrhage, is absorbed in the course of a few days, and the coagulating lymph, which had been effused around it, and had produced a thickened and almost cartilaginous appearance in the parts, is gradually removed, and they again appear more or less completely restored to their cellular texture..

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Nor are these all the changes which the artery undergoes ; for, if examined at a still later period, the ligamentous portion is found to be reduced to a filamentous state, distinguishable from the surrounding cellular membrane only by being somewhat coarser; and thus the obstruction which commenced at the extremity of the canal terminates in the complete annihilation of the artery to the first lateral branch. " But long before this final change is accomplished, many of the lateral branches of the superior and inferior portions of the artery have become very much enlarged, and have established by frequent anastomoses, a free and ready communication between these disunited parts of the trunk. The small branches by whose immediate inosculation these anastomoses are formed, appear to liave undergone the principal changes ; they are not only proportionally more enlarged than the large branches of the limb to which they belong, and very considerably larger than the corresponding branches of the other limb, but have also become longer, and, being confined within their former space, assume a beautiful ?tortuous and serpentine coursc, in order to accommodate themselves to it.
" The circulation appears to be carried on as perfectly and \-igorously by these anastomising branches in the limb, the main artery of which has been divided, as in that in which the artery is entire ; the inferior part of the divided artery, and all its branches, being found fully equal in size to the corresponding part of the trunk and branches of the artery of the opposite limb which has not been divided : and hence, we may conclude, with the celebrated Mr. Hunter, that " Vessels have a power of " increase within themselves, both in diameter and in length, " which is according to the necessity, whether natural or dis-M eased." " I .shall now make some further observations relative to the external. external and internal coagula of blood, and the intermediate one of lymph, which, if introduced before, would have too much interrupted the detail of the process* And first, of the external 'coagulum? " Its particular figure and extent vary according to tile mariner in which the wound has been inflicted. If the artery, its sheath, the vein, and nerve accompanying it, have all been completely divided, the figure and extent of the coagulum \vill depend on the relative retraction of the artery to that of the sheath, which varies in different animals, and according as the artery has been more or less detached from the surrounding cellular substance.
?" ~ " If the artery alone be divided, the anterior part of its sheath having been opened longitudinally, the coagulum which theti ?forms at the mouth of the artery varies from a quarter to near half an inch.in length, and differs from the form of the artery only in being sometimes slightly conical at its extremity ; Which", when the integuments have been sewed up previous to the division of the vessel, is turned forward, and is continuous with a large globular portion of coagulum, which being confined by the' integuments alone, lies over it and the extremity of the artery. This appearance of the external coagulum may readily be accounted for from the circumstance of the sheath not having been divided so as to admit of its retraction; whereas, the complete division of the artery allows it to retract even within the part to which ?the wound of the sheath has extended, and, accordingly, that portion of the coagulum which lies within the entire part of the sheath, assumes the form of the artery ; while the portion of sheath which has been opened, being deprived of the support of the artery, and of its tension, is more or less disposed to collapse, and will necessarily give a conical appearance to the portion of coagulum ?formed within it ; and thus it is that the lower extremity of the -external coagulum is sometimes conical : but when the integuments have been sewed up previous to the division of the artery, in consequence of the impediment which that circumstance aflords to the exit of the blood, even this flaccid portion of the sheath becomes fully distended with blood, and of course the conical form of the external coagulum is prevented.?I have been thus particular in explaining these circumstances, because I wish it to be clearly understood, how a slight difference in the manner of performing the experiments may occasion a variation in the appearance of the parts when examined ; and if, in repeating experiments on this subject, any deviation from the account here given should be observed, 1 am convinced it will be satisfactorily accounted for, by attending to the manner in which the experiment is performed in both instances. " The extent, and, indeed, even the formation of the internal coagulum of blood, depends very much on the distance from a lateral branch, at which the divisipn of the artery has taken ( No. 87", j I i place ; place : thus, if it is divided about a quarter of an inch beyond a branch, there will scarcely be formed any coagulum of this description, for the effusion of lymph at the cut extremity of the artery is in general sufficient to form a coagulum which extends a little way within the artery, and then the space -between the extremity of the coagulum of lymph and the lateral branch is so short, that no internal coagulum of blood can be formed, at least none worth mentioning. In some instances I have found a small lamina of coagulated blood, not thicker than a six-pence> lying 011 the coagulum of lymph, the extremity of which in these eases generally projects a little beyond the extremity of the artery, and extends further within its canal than merely the surface by which it adheres ; which circumstance seems to depend on a iarger quantity of lymph being effused than is necessary to fill up the canal of the artery as far as the inflammation extends on its internal surface, a?d the superfluous quantity not coming in contact with an inflamed surface, and the blood being constantly driven between it and the sides of the artery, it forms 110 adhesion, but projects, a little within the canal. It is probable that the compression, which the lymph undergoes from the gradual contraction-of the extremity of the artery, may also contribute to thjs effect. u But when the division of an artery has taken place at som? distance from a lateral branch, a long conical internal coagulum is then formed, whose base is situated towards the extremity of the artery, and in general it adheres partially at the circumference of its base to the internal surface of the artery, close to the coagulum of the lymph. " The internal coagulum of blood, however, does not fill up the cavity of the artery throughout the whole of its extent; and. though conical, it has often the appearance of not having been formed at once, but by the successive coagulation of small quantities of blood. It is very readily distinguished from the coagulum formed by the effusion of lymph from the inflamed extremity of the artery, which is rather brown than white at first, probably in consequence of some admixture of red particies, and which is principally characterized by adhering almost throughout its whole txtcnt to the internal surface of the artery: whereas the former, i.e. the internal coagulum of blood, although much longer than this of lymph, forms, no adhesion whatever, except a slight one .At its base, and which seems to be produced by the coagulum of blood being formed while the lymph is sufficiently recent to allow it to stick to it. Although the internal coagulum of blood when first formed by no means fills up the canal of the artery, except at its" base; yet, in consequence of the contraction >vhich the portion of artery containing it gradually undergoes, after a short time it embraces the coagulum so closely that they appear to cohere to each other ; so that although the greater pari <s?f the coagulum, .preserving its natural form,-may very easily Dr Jones's Treatise on Hemorrhage. '475 be separated from the artery, yet its internal surface is left of a black colour, as if an external lamina of the coagulum still remained on it. It is also highly worthy of notice, that on ex<amining, at a distant period after these experiments, arteries which, (from similar experiments on the corresponding arteries of othei animals more speedily examined), we know must have had considerable coagula of blood in them ; 110 coagula rhould bo tound in them; but their internal surface is very black, and theit external appearance, previous to being cut open, remarkably dark. 44 From what has been said it appears, that when an artery has been divided at some distance from a lateral branch, three coagula are formed : one of blood, externally, which shuts up its mouth; one of lymph, just within the extremity of its canal'; and one of blood, within its cavity, and contiguous to that of lymph.
. " I have called that of lymph a coagulum, becaufe, when the divided artery has been left entirely to itfelf, there is fuch a quantity of lymph effufed, that although it is firmly united to the internal furface of the artery, it may be confidered as a diilinct fubstance; but, if the cut edges of the extremity of the artery had been kept in contact with each other by pressure, they would have cicatrized, and no coagulum would have been formed; i. e. coagulating lymph would not have been effused in such a quantity as to form a mass of a determinate figure.
" I have already remarked, that when the division of an artery has been made very near to a lateral branch, no internal coaguluni of blood is formed : hence we see that the number of coagula varies according to circumstances. But the external coagulum is / always formed, and is subject to no other variations than those already defcribed. <? The internal coagulum of blood contributes nothing to the suppression of hemorrhage in ordinary accidents, because its formation is uncertain, or when formed it rarely fills the canal of the artery, or, if it fills the canal, does not adhere to the internal coat of the artery. Hitherto, therefore, I have contented myfelf with noticing its existence, or pointing out the circumstance which, prevents its formation, without ranking it amongst the means which Nature employs for the suppression of hemorrhage. But if an artery be lacerated, its internal coat will be torn in many places, in proportion to the degree of violence with which the injury has been inflicted. Under this particular accident the internal coagulum of blood may extend beyond many collateral branches, will fill the canal of the artery,' and will adhere to its surface wherever it is lacerated, inconsequence of lymph being effused from these several wounds of the internal coat. 1 he internal coagulum may in this case avail against a return 9! hemorrhage." The experiments, without doubt, bear our author through all the procefTes he has remarked, and even thro' the caufes to which he afligns thofe proceffes. But it is not enough to fhow, that coa-I i 2 gulum gulum on the part external to the orifice of the divided artery ii the immediate and temporary me.ns of fuppreffing the hemorrhage, or that the coagulum within the orifice is, for the moft, accidental or unneceflary, or even that the future and permanent fuppreflion of the Hemorrhage arifes from the effufion of coagulable lymph at the divided extremities of the internal coat of the velTels. If our Readers (and we are fure all who are worth the ?labour we have willingly bellowed on this article.will) take the trouble of re-perufing our extra&s, as far as the quotation from Mr-Hunter, they will enjoy a fecond time the defcription given by our author of the changes produced in confequence of fo ferious a violence as the divifion of a confiderable artery ; and they will alfo feel, as the author feems to us to have done, not perfectly fatufied with the caufes he aiiigns for fome of the operations he obferved.
. The firft effect of fuch an injury is the coagulation of the blood to flop the orifice. This the author feems to impute (we admit with fome cauiion) to the diminilhed force of the circulation. We ftiould rather impute it to the refources of the economy to pieferva itfelf under certain circumilances. We alfo admit, that thefe resources are not always fufficient; but fuch is the cafe in many other curative intentions of Nature. We well know that the bare ttjjity in the furrounding parts ? In one of our author's expert ; ments, he found that a tea cup. full of blood taken immediately after the incifion into the carotid of a horfe, coagulated in five ? minutes ard a few feconds; the fame quantity, taken a quarter ofan hour after, when the neceffity became more urgent, as the animal ? was much enfeebled, coagulated in three minutes and a half. This fpeedier coagulation could not arife from any difpofition to inflammation from greater powers in the animal; but from an ineffe&ual attempt at fuppreffing the hemorrhage; an attempt, however, which might have been fuccefsful, had all the other resources been : allowed their full effect. We are told, the ftream of blood had diminifhed ; the horfe fell; fhowed great figns of reftlefsnefs; and, to prevent mifchief, was difpatched when in articulo mortis.
The quotation from Mr. Hunter is beautifully illustrated by the pi&ure contained in our author's defcription. We mean not to fpeak of this enlargement of the collateral branches of an oblite-,; rated veflel as a difcovery of late times; it muft have been known as long as the deftru&ion of an artery was known, But we wilh our , readers to remark, that this altered a&ion can only be imputed to the fame ftimulus of neceffity, and is in perfedl harmony with every other procefs we perceive in the blood and the veflels; that is, the parts adt according to a neceffity which arifes for preferving the whole animal, fo that we may, without any ftrain of words, be allowed to impute fuch aftions to the laws conftituted for this parti- The copious extra&s we have already made, and the clofe rea-: foning required to accompany us through thefe obferyations, induce us, at prefent, relu&antly to attend to the limits of our work, and to the patience of our readers. In the next number the fubjeft will Be concluded. find, with a very-few exceptions, Hill greater ennui in the perufal of the ancients. To relieve his reader, however, Mr;, Carmichael begins, by relating his cafes: thefe are certainly very itriking, and.fowell worth recording, that we fometimes wifh the author had referved. his fubfequent reafoning till, he had more completely matured his theory. The cafes are five in number* The fir ft is of.a woman who-: had a foul ulcer en each fide of her nofe, fimilar-to the defcription ufuaiiy given of noli me tangere ; thefe were healed by the internal, ijfe of cicuta and calomel and the fprinkling o'f hydrargyrus muri-,? atas ruber on the parts'; but in about..two. months afterwards, a,foul r i 1 " ulcer P ? } 4^8 Mr. Garmichael, on Carbonate of Iron upon Cancer. ulcer appeared on the lip, which could not he relieved by the fame remedies. This induced the author to confult the modern writers on the fubjeft. By fome accident he was dir*?ted to Dr. Adams's ?w ork, which our readers will recoiled is confined to the cancerous breaft.
" The grounds on which Do&or Adams founded his arguments in favour of the independent life of Cancer, feemed to me not unreafonable, although between that difeafe and Hydatids, I could mot perceive any very great fimilarity. But this obvioufiv led me to the confideration, that if the lives of thofe fuppofed animals were extinguifhed, they would be expelled from the body by fuppuration, ? and as iron has been found to be very effectual in dertroying internal worms, 1 was induced to hope, that it would be equally deilru&ive to other animals of a parafitical nature.?I, therefore, felt myfelf jufl'ified in making trial of a madicine in itfelf harmlefs, the effcdls of which more than anfwered my expectations." By the hiftory of the cafe, it appears not only that the carbonate of iron was fuccefsful, but alfo that as often as that remedy was omitted, by any accident, before the compleat cicatrization of the fore,-the ulcer conilantly fpread, and became ill-conditioned. During the cure, we are told, the ulcer occafionally difchiarged fubftances about the fize of the fmalleft pea.
The fecond cafe was a cancerous ulcer in the external canthus of the eye; this was healed by the fame remedies, carbonate of iron: and in the progrefs, the author reniarked " fmall cavities resembling thofe greater ones obfervable in iffues after the removal of the pea." This appearance, he concludes, was owing to the difcharge of fmall bodies> fimilar to thofe mentioned in the former cafe. < The third cafe was an ulcer of that /pedes,-called Noli Me tangere, in a very young lady. Before we proceed any further, we cannot help confelfing, that we have never met with this difeafe in a very young fubjedt. However, the carbonate of iron cured the complaint in fix days, which had withftood, for as many years, the moft powerful remedies. This ulcer does not appear to have difch'arged any of thofe round fubftances.
The fourth cafe was of a man, forty years of age, with cancerous ulcers on the fcrotum and on the calf of the leg, the latter covered with a number of warty excrefcences. Thefe were all difcharged by the carbonate of iron, and both the ulcers yielded to the ufe of that remedy applied in various ways.
The fifth cafe was of a foldier nearly eighty years of age.?Here alfo the remedy was fuccefsful ; but it will eafily be conceived the patient did riot long outlive the cure of his local complaints.
After the relation of his Cafes, Mr. Carmichael introduces his reafoning by an account of what has been done by the ancients. This begins with Hippocrates, and is purfued as far down as Helvetius. Whether all the intermediate writers are included, we did rot think ic neceflary to enquire, confidering how little was to be learned from thofe who are quoted. In